急诊介入治疗急性大出血的探讨

The investigation of emergency intervention for the treatment of various acute massive hemorrhage

目的：探讨急诊介入治疗各种急性大出血的诊疗与技术要点。方法：回顾性研究2006年1月至2013年12月我院介入科行急诊介入治疗各种急性大出血184例,通过血管造影明确出血血管后,超选择插管至出血动脉,运用明胶海绵、丝线、弹簧圈和聚乙烯醇颗粒进行栓塞。结果：184例中有171例明确出血血管,实施栓塞术,12例消化道大出血DSA检查未能确定出血部位,1例大咯血未找到支气管动脉至造影失败。171例介入治疗患者中治愈132例,显效26例,无效14例,总有效率为92%。无发生严重并发症。结论：我们总结出＂二快＂、＂二定＂、＂三合理＂的治疗原则。运用这项治疗原则有利于介入医生综合应对各种急性大出血的处置,对于保证介入手术成功、挽救患者生命能发挥积极作用。

Objective The Clinical and teehnical points of emergency intervention was evaluated for the treatment of various acute massive hemorrhage . Methods Retrospee tive study. Our study included totally 184 patients with various acute massive hemorrhage from January 2006 to December 2013. We used angiography to confirm the bleeding vessels, and then get into the bleeding vessels by super selective catheterization, then implemented embolization using gelatin sponge , silk threads , coils and polyvinyl alcohol particles. Results Among all 184 patients, we implemented embolization for 171 patients. 12 patients were failed to define the site of hemorrhage,1 patient of massive he- moptysis quitted from the study because we failed to define the bronchial artery. QAmong 171 patients, 132 patients were successfully treated,26 patients resulted in uncom- pletely hemostasis,14 patients were considered as invalid,the total efficient was 92%. No severe adverse events occurred. Conclusion In our study ,we summed up n principle as ＂rapid diagnosis,quickly intervention＂,＂ locate the location of the hemorrhage, define the cause of the bleeding＂ ,＂ reasonable use of target vessels,embolie materials and degree of embolization＂. On the basis of this principle,emergency intervention is effective for the treatment of various acute massive hemorrhage so as to improve the success rate of interventional operation and save the lives of patients.